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Relationship between nursing home quality indicators and potentially preventable hospitalisation
  1. Dongjuan Xu1,
  2. Robert Kane2,
  3. Greg Arling1
  1. 1 School of Nursing, Purdue University, West Lafayette, Indiana, USA
  2. 2 Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
  1. Correspondence to Dr Dongjuan Xu, School of Nursing, Purdue University, West Lafayette 47907, Indiana, USA; xu976{at}


Background Hospitalisations are very common among nursing home residents and many of these are deemed inappropriate or preventable. Little is known about whether clinical care quality is related to hospitalisation, especially potentially preventable hospitalisations (PPHs). Among the few studies that have been conducted, the findings have been inconsistent. The objective of this study was to examine the relationship between quality indicators and overall and PPHs among Medicaid beneficiaries aged 65 years and older receiving care at nursing homes in Minnesota.

Methods 23 risk-adjusted quality indicators were used to assess nursing home quality of care. Quality indicators and other facility-level variables from the Minnesota Nursing Home Report Card were merged with resident-level variables from the Minimum Data Set. These merged data were linked with Medicaid claims to obtain hospitalisation rates during the 2011–2012 period. The sample consisted of a cohort of 20 518 Medicaid beneficiaries aged 65 years and older who resided in 345 Minnesota nursing homes. The analyses controlled for resident and facility characteristics using the generalised linear mixed model.

Results The results showed that about 44 % of hospitalisations were PPHs. Available quality indicators were not strongly or consistently associated with the risk of hospitalisation (neither overall nor PPH). Among these 23 quality indicators, five quality indicators (antipsychotics without a diagnosis of psychosis, unexplained weight loss, pressures sores, bladder continence and activities of daily living [ADL] dependence) were related significantly to hospitalisation and only four quality indicators (antipsychotics without a diagnosis of psychosis, unexplained weight loss, ADL dependence and urinary tract infections) were related to PPH.

Conclusion Although general quality indicators can be informative about overall nursing home performance, only selected quality indicators appear to tap dimensions of clinical quality directly related to hospitalisations.

  • nursing home, potentially preventable hospitalisations, quality indicators

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  • Contributors DX and RK developed the theoretical framework. DX analysed the data. All authors provided critical feedback and helped shape the research, analysis and manuscript. DX and GA contributed to the final version of the manuscript. RK passed away prior to the submission of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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